Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries

Annette Prüss-Ustün*, Jennyfer Wolf, Jamie Bartram, Thomas Clasen, Oliver Cumming, Matthew C. Freeman, Bruce Gordon, Paul R. Hunter, Kate Medlicott, Richard Johnston

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

384 Citations (Scopus)

Abstract

Background: To develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and middle-income countries. Methods: For each of the analysed diseases, exposure levels with both sufficient global exposure data for 2016 and a matching exposure-response relationship were combined into population-attributable fractions. Attributable deaths and disability-adjusted life years (DALYs) were estimated for each disease and, for most of the diseases, by country, age and sex group separately for inadequate water, sanitation and hygiene behaviours and for the cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Findings: An estimated 829,000 WASH-attributable deaths and 49.8 million DALYs occurred from diarrhoeal diseases in 2016, equivalent to 60% of all diarrhoeal deaths. In children under 5 years, 297,000 WASH-attributable diarrhoea deaths occurred, representing 5.3% of all deaths in this age group. If the global disease burden from different diseases and several counterfactual exposure distributions was combined it would amount to 1.6 million deaths, representing 2.8% of all deaths, and 104.6 million DALYs in 2016. Conclusions: Despite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children. These estimates contribute to global monitoring such as for the Sustainable Development Goal indicator on mortality from inadequate WASH.

Original languageEnglish
Pages (from-to)765-777
Number of pages13
JournalInternational Journal of Hygiene and Environmental Health
Volume222
Issue number5
DOIs
Publication statusPublished - Jun 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019

Keywords

  • Burden of disease
  • Comparative risk assessment
  • Diarrhoea
  • Drinking water
  • Hand washing
  • Hygiene
  • Sanitation
  • Water

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